Associations Between Area Deprivation Index and the Time to Presentation of Scaphoid Fractures

TL;DR

This study finds that people from more deprived areas tend to seek treatment for scaphoid fractures later, increasing the risk of complications.

Contribution

The study demonstrates a novel association between area deprivation and delayed presentation of scaphoid fractures, linking socioeconomic factors to medical outcomes.

Findings

Patients from the most deprived areas presented with scaphoid fractures significantly later than those from the least deprived areas.

Higher area deprivation index scores were independently associated with a 23.8% increased odds of nonunion at presentation.

Delayed presentation in deprived areas was linked to a higher prevalence of nonunion at initial evaluation.

Abstract

Scaphoid fractures are the most common carpal fractures and are prone to nonunion because of their retrograde blood supply. Delayed diagnosis or treatment increases the risk of nonunion and progression to scaphoid nonunion advanced collapse. Social determinants of health, measured by the area deprivation index (ADI), may contribute to such delays. This study examines the association between ADI, time to presentation, and the presence of nonunion at initial evaluation.

A retrospective chart review identified 168 patients with suspected scaphoid fractures between January 1, 2018 and June 30, 2025. State-level ADI scores were grouped into the following terciles: least-deprived (LDT), intermediately deprived (IDT), and most deprived (MDT). Patients presenting more than 5 years after injury or without confirmed fractures were excluded, leaving a total of 107 patients. Independent t tests compared the mean time from injury to presentation across ADI terciles, χ2 tests compared the nonunion rates at presentation, and binomial regression assessed whether ADI predicted scaphoid nonunion.

The mean time from injury to presentation increased with deprivation: LDT = 16.9 ± 23.5 days, IDT = 55.1 ± 97.9 days, and MDT = 173.5 ± 364.5 days. Both MDT and IDT patients presented significantly later than LDT patients (P = .0146 and P = .0315, respectively) and had a higher prevalence of nonunion at presentation (P = .025). The ADI independently predicted scaphoid nonunion, with each unit increase in state ADI associated with 23.8% higher odds of nonunion (P = .029).

Patients from socioeconomically deprived communities experienced significantly longer delays in presentation for scaphoid fractures and a higher incidence of nonunion, which may increase the risk of long-term complications such as scaphoid nonunion advanced collapse wrist arthritis. These findings highlight the importance of addressing neighborhood-level disparities to increase access to treatment in time-sensitive injuries such as scaphoid fractures.

Prevalence IIIb.

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